Background: Abdominally based perforator free flaps are commonly used in reconstructive breast surgery. Pre-operative assessment using a variety of imaging techniques has become increasingly popular to assess the anatomy of the abdominal perforators. We hypothesize that color flow duplex ultrasonography is a reliable method for mapping the abdominal perforator anatomy and avoids the complications associated with other methods.
Material/Methods: A prospective study of 40 consecutive patients was performed. Pre-operative color flow duplex ultrasound evaluation was compared to intra-operative findings of the dominant epigastric perforator selected at the time of flap harvest.
Results: Forty consecutive patients were evaluated prospectively. Forty six flaps were harvested from these patients (6 bilateral cases). A single perforator which was identified by both pre-operatively and at the time of intra-operative flap harvest as the dominant perforator was identified in 36 of 46 flaps (78.3%). The intra-operative perforator chosen at the time of flap harvest was identified as one of the pre-operative perforators marked by duplex ultrasonography in 45 or 46 patients (97.8%).
Conclusions: Pre-operative duplex ultrasonography is a safe and reliable tool for assessing the abdominal epigastric perforators used in autologous microvascular breast reconstruction. Advantages of this technique are: it is non-invasive, it does not require contrast agent application, no radiation, and it is inexpensive when compared to other imaging modalities.

Keywords: Prospective Studies, Preoperative Care, Microvessels - ultrasonography, Mammaplasty - methods, Intraoperative Care, Color, Abdomen - ultrasonography, Ultrasonography, Doppler, Duplex